Acute brain injuries (“ABI”) due to trauma, stroke, seizures, hypoxia, and infections affect more than 10 million Americans annually. They are a leading cause of death and disability, and cost society over $60 billion dollars annually. A major reason for poor outcomes from ABIs is the “secondary injury” to the brain. This term refers to potentially preventable brain damage that is added to and complicates the original or “primary” injury. Secondary injury is usually due to insufficient oxygen or circulation to the brain to meet its demands. This can be caused by upper airway obstruction, blood loss, hypotension, brain swelling (cerebral edema), seizures, delayed cerebral hemorrhage, and increased intracranial pressure, among others. Brain injury is exquisitely time dependent. Even brief delays of a few minutes in preventing or reversing secondary brain injury may result in permanent and fatal damage. A device, which rapidly detects, monitors and communicates the real-time and dynamic condition of brain function during an ABI could markedly improve the timeliness and appropriateness of corrective intervention. Having this information immediately available where the victim is first triaged and stabilized, which is usually in the field by paramedic-emergency medical technologists, would minimize any delay in corrective and preventive intervention.
The heart and the brain are the two largest electricity-generating organs in the body and the two most critical to survival in acute injuries. For more than forty years in acute cardiac injury the EKG has been a standard of care, serving the diagnostic and monitoring functions described above. In ABI, however, no equivalent tool has been established. The most logical candidate is the EEG (electroencephalogram), which has been available for decades as a routine. method for diagnosing normal and abnormal brainwave activity in chronic diseases. In spite of striking similarities between the EKG and EEG in their electrophysiology, methodology, and clinical utility, the EEG, unlike the EKG, has never been systematically applied to acute injuries. The main reason for this omission is, traditionally, that EEG has been perceived as a complex and highly sophisticated procedure, which requires specially trained experts to set up, run and interpret a study. These experts are not readily available in emergency settings, particularly at the scene of ABIs in the field. In addition, unlike the case with EKG testing, emergency medical, paramedical, and allied health professionals who attend victims of ABIs are not trained in EEG set-up or interpretation, nor are these considered within their usual scope of practice.
A method for using computerized telecommunication technology with real-time interpretation by one or more remote EEG expert readers may help, but does not fully solve this problem. It would be beneficial for an emergency team to have equipment on site that, like modern computerized EKG machines, rapidly performs a brainwave test and automatically determines if the brain function is normal or abnormal, as well as provide simple and reliable key diagnostic information.
What is needed is a “self-interpreting” EEG unit, which can be set-up to acquire brainwaves by non-experts at the ABI site, and provide rapid automated interpretation in clinically meaningful terminology.